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Home 9 Public Resources 9 ISTSS Briefing Papers 9 Improving Access to Evidence-Based Interventions for Trauma-Exposed Adults in LMICs

Improving Access to Evidence-Based Interventions for Trauma-Exposed Adults in LMICs

Briefing Paper Working Group Members

Debra Kaminer, PhD
University of Cape Town, South Africa

Duane D. Booysen, PhD
Rhodes University, South Africa

Kate Ellis, PhD
American University in Cairo, Egypt

Christian H. Kristensen, PhD
Pontifical Catholic University of Rio Grande do Sul, Brazil

Anushka R. Patel, PhD
Harvard University, United States

Katy Robjant, PhD‎
University of Konstanz, Germany

Srishti Sardana, PhD 
Johns Hopkins University, United States

The authors gratefully acknowledge valuable input from Drs. Rachel Hiller, Debra ‎Kaysen, Judith Bass, Christine Bourey, Jaimie Gradus, Angela Nickerson, Elana ‎Newman, and Kathryn Magruder, of the ISTSS Public Health and Policy ‎Committee, and Diane Elmore Borbon of the ISTSS Executive Office.   ‎

Suggested citation: Kaminer, D., Booysen, D. D., Kristensen, C. H., Ellis, K., Patel, A. R., ‎Robjant, K., & Sardana, S. (2023). Improving Access to Evidence-Based Interventions for ‎Trauma-Exposed Adults in Low- And Middle-Income Countries: An International Society ‎for Traumatic Stress Studies Briefing Paper. Retrieved from: https://istss.org/public-‎resources/istss-briefing-papers/briefing-paper-improving-access-lmics


In low- and middle-income countries (LMICs), the mental health consequences of trauma ‎exposure pose a substantial personal, societal, and economic burden. Yet, the significant ‎need for evidence-based mental health treatment remains largely unmet. To unlock the ‎potential for mental health care for trauma survivors in lower-resource contexts, it is critical ‎to recognize obstacles to receiving treatment and identify strategies to improve access to ‎evidence-supported interventions.‎

Multiple treatment barriers prevent help-seeking for individuals living with trauma-related ‎mental health difficulties in LMICs. These include attitudinal barriers (such as a low ‎perceived need for treatment, stigma, and a lack of confidence in the effectiveness of ‎treatment) and resource-related barriers (such as a scarcity of mental health specialists, ‎prohibitive treatment costs, and an absence of nearby services). There is an urgent need ‎for effective strategies to reduce these barriers. This briefing paper highlights several ‎innovative, evidence-based approaches that can be harnessed to better meet the ‎treatment needs of trauma-exposed adults in lower-resource settings. These include ‎training a cadre of non-specialist mental health providers from local communities, ‎developing culturally informed and co-developed access and intervention strategies, the ‎use of digital technology to deliver scalable public health messaging and mental health ‎intervention, and the delivery of programs that address a range of trauma-related mental ‎and behavioral health difficulties. ‎

Based on existing evidence regarding treatment barriers and strategies to address these, ‎key recommendations for improving access to evidence-based mental health interventions ‎for adult survivors of trauma in LMICs are as follows. More detailed recommendations ‎spanning public health and policy, research, and practice, are located at the end of the ‎document‎.